老年人无既往筛查史时是否应考虑进行结直肠癌筛查？一项成本效益分析。
Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.
出版信息
Ann Intern Med. 2014 Jun 3;160(11):750-9. doi: 10.7326/M13-2263.
BACKGROUND
The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.
OBJECTIVE
To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.
DESIGN
Microsimulation modeling study.
DATA SOURCES
Observational and experimental studies.
TARGET POPULATION
Unscreened persons aged 76 to 90 years with no, moderate, and severe comorbid conditions.
TIME HORIZON
Lifetime.
PERSPECTIVE
Societal.
INTERVENTION
One-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.
OUTCOME MEASURES
Quality-adjusted life-years gained, costs, and costs per quality-adjusted life-year gained.
RESULTS OF BASE-CASE ANALYSIS: In unscreened elderly persons with no comorbid conditions, CRC screening was cost-effective up to age 86 years. Screening with colonoscopy was indicated up to age 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years (colonoscopy indicated up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years). In unscreened persons with severe comorbid conditions, screening was cost-effective up to age 80 years (colonoscopy indicated up to age 77 years, sigmoidoscopy at age 78 years, and FIT at ages 79 and 80 years).
RESULTS OF SENSITIVITY ANALYSES
Results were most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained.
LIMITATION
Only persons at average risk for CRC were considered.
CONCLUSION
In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.
PRIMARY FUNDING SOURCE
National Cancer Institute.
背景
美国预防服务工作组建议，对于充分筛查的 75 岁以上人群，不常规进行结直肠癌（CRC）筛查，但未针对无既往筛查史的老年人进行筛查的适宜性提出建议。
目的
确定应在哪些年龄段对未经筛查的老年人进行 CRC 筛查，并确定每个年龄段的适宜筛查方法。
设计
微观模拟建模研究。
数据来源
观察性和实验性研究。
目标人群
76 岁至 90 岁、无、中度和重度合并症的未筛查人群。
时间范围
终生。
视角
社会视角。
干预措施
一次性结肠镜检查、乙状结肠镜检查或粪便免疫化学检测（FIT）筛查。
结果测量
获得的质量调整生命年数、成本和每获得一个质量调整生命年的成本。
基础案例分析结果
在无合并症的未筛查老年人中，CRC 筛查在 86 岁之前具有成本效益。在 83 岁之前，结肠镜检查是适宜的；84 岁时，乙状结肠镜检查是适宜的；在 85 岁和 86 岁时，FIT 是适宜的。在有中度合并症的未筛查人群中，筛查在 83 岁之前具有成本效益（在 80 岁之前，结肠镜检查是适宜的，81 岁时乙状结肠镜检查是适宜的，在 82 岁和 83 岁时 FIT 是适宜的）。在有严重合并症的未筛查人群中，筛查在 80 岁之前具有成本效益（在 77 岁之前，结肠镜检查是适宜的，78 岁时乙状结肠镜检查是适宜的，在 79 岁和 80 岁时 FIT 是适宜的）。
敏感性分析结果
结果对假设每获得一个质量调整生命年的支付意愿较低最为敏感。
局限性
仅考虑 CRC 平均风险人群。
结论
对于未经筛查的老年人，CRC 筛查应考虑在 75 岁以上的年龄进行。大多数情况下，结肠镜检查是适宜的。
主要资金来源
美国国家癌症研究所。
Zotero 插件